Published online May 21, 2023. doi: 10.3748/wjg.v29.i19.3040
Peer-review started: March 14, 2023
First decision: April 10, 2023
Revised: April 17, 2023
Accepted: April 25, 2023
Article in press: April 25, 2023
Published online: May 21, 2023
Processing time: 62 Days and 18.2 Hours
Hepatitis C infection not only damages the liver but also often accompanies many extrahepatic manifestations. Incidences of pulmonary hypertension (PH) caused by hepatitis C are rare, and incidences of concurrent nephrotic syndrome and polymyositis are even rarer.
Herein we describe the case of a 57-year-old woman who was admitted to our department for intermittent chest tightness upon exertion for 5 years, aggravated with dyspnea for 10 d. After relevant examinations she was diagnosed with PH, nephrotic syndrome, and polymyositis due to chronic hepatitis C infection. A multi-disciplinary recommendation was that the patient should be treated with sildenafil and macitentan in combination and methylprednisolone. During treatment autoimmune symptoms, liver function, hepatitis C RNA levels, and cardiac parameters of right heart catheterization were monitored closely. The patient showed significant improvement in 6-min walking distance from 100 to 300 m at 3-mo follow-up and pulmonary artery pressure drops to 50 mmHg. Long-term follow-up is needed to confirm further efficacy and safety.
Increasing evidence supports a relationship between hepatitis C infection and diverse extrahepatic manifestations, but it is very rare to have PH, nephrotic syndrome, and polymyositis in a single patient. We conducted a literature review on the management of several specific extrahepatic manifestations of hepatitis C.
Core Tip: Hepatitis C virus (HCV) infection should be considered a systemic disease which is often associated with many extrahepatic manifestations, but it is very rare to have multiple different extrahepatic manifestations in a single patient. In this article, we report a case of pulmonary hypertension (PH), nephrotic syndrome, and polymyositis due to HCV infection. The optimal treatment strategy for hepatitis C-related extrahepatic manifestations remains to be determined. Our case confirms sildenafil and macitentan as effective treatment option for patients suffering from PH due to hepatitis C infection. However, randomized, controlled trials are warranted to confirm the present results.